title: Long-term follow-up for salvage laparoscopic pyeloplasty after failed open pyeloplasty.
abstract: OBJECTIVE
  To report our long-term experience with salvage laparoscopic pyeloplasty after a failed open procedure. Laparoscopic repair of a primary ureteropelvic junction obstruction (UPJO) is associated with very high long-term success. However, there are limited data on patients who have failed previous open pyeloplasty. We have determined that salvage laparoscopic pyeloplasty is an excellent option for these patients.
  
  
  METHODS
  We queried our laparoscopic pyeloplasty database of 367 patients from July 1994 to May 2007 for patients who had undergone prior open pyeloplasty. We analyzed demographic data, perioperative course, complications, and follow-up studies on identified subjects. We assessed clinical status by verbal pain scale and diagnostic studies. Radiologic follow-up consisted of diuretic renal scan, intravenous pyelography, or both.
  
  
  RESULTS
  We identified 9 patients (2.5%) who underwent salvage laparoscopic pyeloplasty for persistent obstruction after open pyeloplasty. The mean age of our cohort was 30.5 years (range, 19-50 years). Mean operative time was 204 minutes (range, 80-264 minutes), estimated blood loss was 105 mL (range, 20-300 mL), and mean length of stay was 2.1 days (range, 2-3 days). No intraoperative or postoperative complications were reported. All patients reported relief of symptoms in the immediate postoperative period. At a median follow-up of 66 months (range, 12-119 months), 8 of 9 patients (89%) had clinical and radiologic resolution of UPJO with stable renal function, pain free status, and a patent ureteropelvic junction. The remaining patient failed laparoscopic repair within the first year with evidence of persistent obstruction, necessitating endopyelotomy.
  
  
  CONCLUSIONS
  Our findings support the use of salvage laparoscopic pyeloplasty as an excellent option for patients who failed previous open pyeloplasty. This approach provides durable long-term outcomes.
authors.affiliation: Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA.
authors.forename: Edan Y
authors.initials: EY
authors.lastname: Shapiro
authors.forename: Jane S
authors.initials: JS
authors.lastname: Cho
authors.forename: Arun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Casey A
authors.initials: CA
authors.lastname: Seideman
authors.forename: Chad P
authors.initials: CP
authors.lastname: Huckabay
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Lee
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D017211:Treatment Failure; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult